Introduction: Pruritus in hemodialysis patients has long been underestimated despite its impact on quality of life and mortality.The DOPPS study revealed a 17% increase in mortality among patients with itch, underscoring its clinical relevance.Recent evidence suggests BNP may contribute to pruritus, particularly in fluid-overloaded states.This study investigates the relationship between BNP, intracranial pressure (ICP), and itch severity using non-invasive retinal imaging.Methods: Hospitalized hemodialysis patients at Juntendo University Shizuoka Hospital (June 2019-December 2021) underwent optical coherence tomography (OCT) to assess ICP-related retinal changes.Parameters included retinal nerve fiber layer (RNFL) thickness, rim area, optic disc area, cup-to-disc ratio, and cup volume.Pruritus severity was evaluated using a Visual Analogue Scale (VAS) and Dermatology Life Quality Index (DLQI).BNP and other clinical data were collected pre-and post-dialysis.A two-day protocol included OCT and VAS/DLQI assessments before and after dialysis.Statistical analysis was performed using JMP Ver.10 (p<0.05).Results: Of 40 enrolled patients, 38 completed the protocol.The cohort included a high proportion of critically ill individuals, with 52.6% having diabetic nephropathy.No direct correlation was found between BNP levels and VAS or DLQI scores.However, OCT parameters showed significant associations with itch severity and QOL.Pre-dialysis rim area negatively correlated with Pre-VAS (r 2 =0.115, p=0.0375),Post-VAS (r 2 =0.111, p=0.0406), and DLQI (r 2 =0.221, p=0.0029).Optic disc area correlated negatively with Day2-VAS (r 2 =0.263, p=0.0105), while cup volume correlated positively with DLQI (r 2 =0.263, p=0.001).RNFL thickness correlated positively with BNP both pre-(r 2 =0.177, p=0.0085) and postdialysis (r 2 =0.197, p=0.0085), suggesting a link between BNP and ICP.Conclusion: Retinal parameters measured via OCT-especially rim area and cup volume-were significantly associated with pruritus severity and QOL in hemodialysis patients, indicating a potential link between ICP and itch.While BNP levels correlated with RNFL thickness, they did not directly reflect itch scores, possibly due to BNP's complex distribution in cerebrospinal fluid.Given the limitations of direct CSF sampling, retinal imaging may offer a viable surrogate for ICP assessment.These findings propose a novel pathophysiological framework for dialysis-related pruritus and warrant further investigation.I have declared that this abstract was also submitted for 67th.Annual Meeting of Japanese Society for Dialysis Therapy.I also declare that re-submitting the abstract is permitted by the organizers of the original meeting.I have no potential conflict of interest to disclose.I used generative AI and AI-assisted technologies in the writing process.
Tun et al. (Wed,) studied this question.